Faculty Bibliography

Borderline personality disorder (BPD) is a complex mental disorder that straddles the line between psychosis and neurosis. As such, questions about the moral and legal responsibility of persons with BPD are especially vexing. Persons suffering with borderline personality disorder typically are impulsive and suffer from impaired volition. They also lack a stable sense of self. Nonetheless, persons with borderline personality disorder often hold long-term, stable preferences-often related to discontinuing particular problematic behaviors-and have a degree of capacity that we argue creates prima facie conditions for holding them ethically and legally responsible. However, this limited capacity often falls short in smoothly accommodating day-to-day relationships. We argue that while a certain degree of accommodation is appropriate for persons with BPD, the diagnosis of BPD does not by itself provide sufficient grounds for voiding responsibility for criminal acts. Using a hierarchical theory of autonomy recognizing first- and second-order volition, we propose a sliding scale be used to ascertain the degree to which a person with BPD should be exculpated weighing the graveness of the act against an estimation of the congruence of second- and first-order volitions.

There may once have been a time when doctors unquestioningly accepted the government's declaration of a drug's effectiveness and when patients unquestioningly accepted the prescriptions of their doctors. That time has passed. Now, information-good and bad-showers from all directions on patients and physicians alike. A filter is needed, and peer review provides the best one. But who or what is this validated information for? Ethically, its primary purpose is to enable patients to make decisions consistent with their values. Providing vetted information in a form that is useful to patients requires an emphasis on comprehensible, comprehensive, trustworthy, verifiable, and transparent communication. The hypothetical comparative effectiveness case study in this month's Health Affairs does not appear to rise to the level that would be helpful to providers or patients.

Can parents who choose not to vaccinate their children be held legally liable for any harm that results? The state of laboratory and epidemiological understanding of a disease such as measles makes it likely that a persuasive causal link can be established between a decision to not vaccinate, a failure to take appropriate precautions to isolate a non-vaccinated child who may have been exposed to measles from highly vulnerable persons, and a death. This paper argues that, even if a parent chooses to not vaccinate a child under a state law permitting exemptions, that decision does not create complete protection against liability for the adverse consequences of that choice.